Podcast
Questions and Answers
In a patient with a kidney transplant presenting with potential BKV nephropathy, which diagnostic method would provide the most definitive confirmation?
In a patient with a kidney transplant presenting with potential BKV nephropathy, which diagnostic method would provide the most definitive confirmation?
- Kidney biopsy with immunohistochemical (IHC) analysis for viral antigens. (correct)
- PCR assay of urine to detect BKV DNA.
- Analysis of urine for the presence of decoy cells.
- PCR assay of blood to quantify BKV viral load.
A bone marrow transplant recipient develops hemorrhagic cystitis. What is the MOST appropriate initial step in managing this condition, based on the information?
A bone marrow transplant recipient develops hemorrhagic cystitis. What is the MOST appropriate initial step in managing this condition, based on the information?
- Administering high-dose corticosteroids to reduce inflammation.
- Initiating antiviral therapy with leflunomide.
- Performing cystoscopy to cauterize bleeding vessels.
- Reducing the dose of immunosuppressant medications. (correct)
Which of the following neurological manifestations is MOST closely associated with progressive multifocal leukoencephalopathy (PML) due to JC virus infection?
Which of the following neurological manifestations is MOST closely associated with progressive multifocal leukoencephalopathy (PML) due to JC virus infection?
- Seizures and loss of consciousness.
- Rapidly progressive dementia with myoclonic jerks, similar to Creutzfeldt-Jakob disease.
- Progressive motor deficits, cognitive decline, and personality changes. (correct)
- Symmetric ascending paralysis resembling Guillain-Barré syndrome.
What is the underlying mechanism by which JC virus leads to the neurological deficits observed in progressive multifocal leukoencephalopathy (PML)?
What is the underlying mechanism by which JC virus leads to the neurological deficits observed in progressive multifocal leukoencephalopathy (PML)?
In the context of ureteral stenosis secondary to BKV infection, what is the rationale for using balloon dilation and stenting as a treatment strategy?
In the context of ureteral stenosis secondary to BKV infection, what is the rationale for using balloon dilation and stenting as a treatment strategy?
Considering the transmission routes of BKV and JCV, what infection control measure would be MOST effective in preventing their spread within a healthcare setting?
Considering the transmission routes of BKV and JCV, what infection control measure would be MOST effective in preventing their spread within a healthcare setting?
Which of the following factors is MOST critical in determining whether an individual infected with BKV or JCV will develop symptomatic disease?
Which of the following factors is MOST critical in determining whether an individual infected with BKV or JCV will develop symptomatic disease?
What is a key difference in the diagnostic approach for PML caused by JCV compared to BKV-associated nephropathy?
What is a key difference in the diagnostic approach for PML caused by JCV compared to BKV-associated nephropathy?
What is the primary reason that there is no direct antiviral treatment option for progressive multifocal leukoencephalopathy (PML)?
What is the primary reason that there is no direct antiviral treatment option for progressive multifocal leukoencephalopathy (PML)?
A patient with a history of kidney transplant presents with decreased urination, flank pain, and hydronephrosis on imaging. What is the MOST likely underlying mechanism connecting BKV infection to these findings?
A patient with a history of kidney transplant presents with decreased urination, flank pain, and hydronephrosis on imaging. What is the MOST likely underlying mechanism connecting BKV infection to these findings?
Flashcards
BKV (Polyomavirus)
BKV (Polyomavirus)
Can cause hemorrhagic cystitis (bloody urine) in immunocompromised and bone marrow transplant patients.
JCV (Polyomavirus)
JCV (Polyomavirus)
Associated with progressive multifocal leukoencephalopathy (PML), a demyelinating disease, in immunocompromised patients.
BKV/JCV Transmission
BKV/JCV Transmission
Mainly through respiratory droplets or contaminated food.
Ureteral Stenosis (BKV)
Ureteral Stenosis (BKV)
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BKV/JCV Diagnosis
BKV/JCV Diagnosis
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BKV Treatment
BKV Treatment
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PML (JCV)
PML (JCV)
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PML Diagnosis (JCV)
PML Diagnosis (JCV)
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PML Treatment (JCV)
PML Treatment (JCV)
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BKV Latency & Kidney Impact
BKV Latency & Kidney Impact
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Study Notes
- Polyomaviruses can transform normal cells in culture and induce tumors in other species.
- Human polyomaviruses BKV and JCV are common, but usually don't cause disease in healthy individuals.
- BKV is named after the patient it was first identified in, BK virus.
- JCV stands for John Cunningham virus, named after the patient in whom the virus was first identified.
- BKV can cause hemorrhagic cystitis in immunocompromised patients.
- JCV is associated with progressive multifocal leukoencephalopathy (PML) in immunocompromised patients, a rare, fatal, demyelinating disease.
- Polyomaviruses are non-enveloped viruses with double-stranded circular DNA.
- Most people are infected with these viruses but only get sick if immunocompromised.
- BKV can cause nephropathy and graft rejection in kidney transplant patients.
BKV
- Can remain latent in renal tubular epithelial cells.
- Spreads through respiratory droplets or contaminated food.
- Can cause ureteral stenosis, leading to hydronephrosis.
- Diagnosis involves PCR for viral DNA in blood and urine, detecting infected renal epithelial cells (decoy cells) in urine, and kidney biopsy with IHC (gold standard).
- Treatment includes reducing immunosuppression, antivirals, hemorrhagic cystitis treatment (catheter and bladder flushing), and ureteral stenosis treatment (balloon dilation and stenting).
- Typically infects the urinary system of immunocompromised individuals, especially transplant recipients on immunosuppressants.
- Most people are infected with BKV during childhood.
- Initial infection is usually asymptomatic or causes mild cold-like symptoms.
- Hemorrhagic cystitis symptoms: bloody urine, increased urination frequency, inability to urinate due to clots, lower abdominal pain.
- Ureteral stenosis symptoms: decreased urination and flank pain.
- Nephropathy symptoms: increased nighttime urination, edema, fatigue, and breathlessness.
- Regular screening is done in transplant recipients using PCR assays.
- Leflunomide, can be used in the case of BKV nephropathy
JCV
- Typically remains latent in kidneys, but can activate in immunocompromised people.
- Enters the bloodstream, crosses the blood-brain barrier, and infects the brain.
- Transmitted through respiratory and gastrointestinal routes.
- PML causes destruction of oligodendrocytes, leading to weakness, loss of coordination, vision changes, slurred speech, personality changes, and cognitive decline (dementia).
- PML can be fatal in 50% of cases.
- Diagnosis involves CSF PCR and MRI showing multiple white matter lesions.
- No direct cure, but disease progression can be slowed by boosting immune function (stopping immunosuppressants or treating HIV with HAART).
- Attacks oligodendrocytes in the brain, causing demyelination of axons.
- Symptoms depend on where demyelination occurs, including motor and cognitive issues.
- PML is suspected when immunosuppressed individuals develop new neurologic symptoms.
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